KDOQI GUIDELINE 6. MARKERS OF CHRONIC KIDNEY DISEASE OTHER THAN PROTEINURIA.doc

KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification PART 5. EVALUATION OF LABORATORY MEASUREMENTS FOR CLINICAL ASSESSMENT OF KIDNEY DISEASE GUIDELINE 6. MARKERS OF CHRONIC KIDNEY DISEASE OTHER THAN PROTEINURIA Markers of kidney damage in addition to proteinuria include abnormalities in the urine sediment and abnormalities on imaging studies. Constellations of markers define clinical presentations for some types of chronic kidney disease. New markers are needed to detect kidney damage that occurs prior to a reduction in GFR in other types of chronic kidney diseases. Urine sediment examination or dipstick for red blood cells and white blood cells should be performed in patients with chronic kidney disease and in individuals at increased risk of developing chronic kidney disease. Imaging studies of the kidneys should be performed in patients with chronic kidney disease and in selected individuals at increased risk of developing chronic kidney disease. Although several novel urinary markers (such as tubular or low-molecular weight proteins and specific mononuclear cells) show promise of future utility, they should not be used for clinical decision-making at present. Background Abnormal urinary excretion of albumin and total protein (Guideline 5) is a highly sensitive indicator of glomerular disease. The results of urine sediment examination and of imaging studies of the kidney, however, can also suggest other types of chronic kidney diseases, including vascular, tubulointerstitial, and cystic diseases of the kidney. In addition, proteins other than albumin in the urine may indicate tubulointerstitial injury. At present, there are no clinically proven markers specific for tubulointerstitial or vascular diseases of the kidney. The purpose of this guideline is to review: abnormalities of urine sediment and abnormalities of imaging studies associated with kidney damage; the relationships of these abnormalities to